SMC rejects Roche's Avastin for ovarian cancer, but six new drugs are in

Cost regulators for the National Health Service in Scotland have closed the door to Roche’s Avastin for ovarian cancer, but six new medicines were waved through.

The Scottish Medicines Consortium said it couldn’t accept Avastin’s use in the ovarian cancer setting because it was not satisfied about cost-effectiveness, despite the drug having been considered under the PACE (Patient and Clinical Engagement) option which gives patients and clinicians a much stronger voice in the decision-making process for end-of-life or rare disease treatments.

On the plus side for patients, the SMC approved funding for new therapies addressing multiple sclerosis, chronic pulmonary disorder (COPD), the skin conditions rosacea and urticaria, colorectal cancer and cystic fibrosis.

First up, Merck Serono’s Erbitux (cetuximab) was accepted for restricted use as a first-line therapy in metastatic colorectal cancer, the third most common cancer in Scotland, with numbers increasing by around 5% in the last 10 years.

The recommendation, which took into account views from a PACE meeting, is contingent upon the continued provision of Patient Access Scheme (PAS) that improves the drug’s the cost-effectiveness.

Gilead Sciences’ Cayston (aztreonam lysine) was accepted also under the PACE process for restricted use for suppressive therapy of chronic lung infections caused by the organism Pseudomonas aeruginosa in patients with CF.

The SMC noted that Cayston improves lung function and respiratory symptoms, helping patients to undertake a more active life, and has the advantage of easy administration that enables treatment away from home. It has been restricted to use in patients in whom conventional therapies are ineffective or not tolerated, and the nod is also dependent on a PAS.

Novartis’ Xolair (omalizumab) is in as a treatment of chronic spontaneous urticaria, a serious skin condition that causes wheals or hives to appear suddenly, often with no known cause, with the help of a PAS.

Its use in Scotland has been restricted to adults and adolescents with chronic spontaneous urticaria who have an inadequate response to combination therapy with H1 antihistamines, leukotriene receptor antagonists (LTRA) and H2 antihistamines, used according to current treatment guidelines.

Biogen Idec’s Plegridy (peginterferon-beta-1a) was green-lighted for the treatment of relapsing remitting forms of MS, which affects around 85% of MS patients. A submission from the Multiple Sclerosis Trust stressed that the drug can offer patients an improved quality of life as it requires fewer injections per week than other currently available treatments, the SMC noted.

Boehringer Ingelheim’s Stiverdi Respimat (olodaterol respimat) was found to be a cost-effective option for use in COPD, on the basis that is can improve symptoms of shortness of breath, improve exercise capacity and lead to reduced use of rescue medication.

And lastly for this batch, Galderma’s Mirvaso (brimonidine gel) has been accepted for restricted use in erythema (excessive reddening of the skin) that occurs on the face in rosacea, a chronic inflammatory skin condition, typically affecting adults between 30 to 50 years of age. There is no current treatment for these patients who to date have depended on lifestyle advice to avoid triggers such as sunlight, alcohol and stress.